INTRODUCTION
The 2018 Cape Town Declaration identifies the activities of the tobacco
industry as incompatible with the human right to health1. The Global Burden of Disease Study estimates the
annual global death toll from smoking to be 8.71 million2. Through the cultivation, production, processing and
disposal of its products, the industry creates a substantial burden on
the environment, which falls mainly in low and middle-income countries3. Tobacco multinationals stand condemned as a major
obstacle to the achievement of the UN’s sustainable development goals4.
Based on its market share of at least 12% of cigarettes sold worldwide,
(https://tobaccotactics.org/wiki/philip-morris-international/),
Philip Morris International (PMI) kills more than a million people per
year. PMI’s bid to take over Vectura, an inhaler company whose products
are used extensively by people with COPD and asthma, conditions caused
and aggravated by its products, is therefore a cause for concern. A
range of consequences follow from such a takeover. Vectura, its
employees, and anyone continuing to work for or collaborate withVectura, become excluded from membership of respiratory professional
societies as well as collaboration with academic institutions, on grants
and from publication in medical journals5,6. The
details of these policies vary, but as an example, the European
Respiratory Society excludes anyone with tobacco industry links in the
last 10 years. Many Vectura scientists will choose to leave rather than
face long-term pariah status. Policies that exclude the tobacco industry
from interaction with government (Article 5.3 of the WHO’s Framework
Convention on Tobacco Control) would also apply to Vectura.
Vectura currently receives income from the sale of a range of inhalers
currently in widespread use. If a takeover by PMI goes ahead, The
European Respiratory Society states
that “health professionals will
avoid prescribing drugs from any company that enriches the tobacco
industry due to the ethical implications”.5 Patients
with lung disease are also likely to be reluctant to use tobacco
industry linked devices.
We discuss the ethical issues raised around choice of medication in this
context, and present potential alternative medications for clinicians,
commissioners and patients considering switching.